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Genitourinary Cancer

The Genitourinary Tumors Program at the Gill Center is one of only a handful of its kind in the country. Over the last decade, the program has become known for exceptional clinical care – particularly surgical expertise – and notable scientifc advances in understanding the molecular abnormalities of these cancers.

Surgical Expertise

Pediatric genitourinary cancers are uncommon, accounting for just 10% of all childhood cancers. At the Gill Center, our medical team treats every type of genitourinary cancer, including germ cell tumor (GCT), Wilms tumor and other cancers arising in the kidney, ureter, testis, ovary and urinary bladder.

Each month a team of specialists, including urologists, pathologists, general surgeons, radiologists and others, convene to develop and review treatment plans for new and existing patients. The most common treatment is a combination of surgery and chemotherapy. Given the prominence of surgery in these treatment plans, our staff intentionally pursues advances in non-invasive surgery. For example:

In 2012, our team published a paper in the Journal of Endourology on the successful use of robot-assisted laparoscopic retroperitoneal lymph node dissection in adolescents with paratesticular rhabdomyosarcoma and testicular germ-cell tumors (T-GCT).

Research

Zebrafish Research Advances Science

While treatment for most GCT is effective – better than a 90% cure rate – the toxicity of chemotherapy creates an incentive to develop molecularly guided therapies. This is especially the case given an inexplicable rise in T-GCT among adolescent boys.

James Amatruda, M.D., Ph.D., is among a small handful of researchers worldwide leading the way on genitourinary cancer research. For years, the genes controlling the differentiation of GCT remained unknown. Over the past fve years, though, through a series of more than seven published papers, Dr. Amatruda and his colleagues have begun to unravel the molecular circuitry of GCTs. His group developed a novel zebrafsh model of GCT, and identifed a genetic mutation in Bone Morphogenetic Protein (BMP) receptor, a cell signaling pathway, as the cause of GCTs in the model. They then validated that the same pathway is defective in GCTs occurring in children. The Amatruda lab has also defned how altered gene methylation – a genetic control mechanism that is especially important in childhood cancers – contributes to GCT. Dr. Amatruda is currently working on new treatment therapies to bring his translational work from lab to bedside.